Tubal ligation: Difference between revisions
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[[Tubal ligation]], also called getting one's tubes tied, and sometimes used to mean a bilateral salpingectomy (destroying both fallopian tubes), is a form of sterilization. Any method of tubal ligation works by stopping the path the egg cell would travel through the fallopian tube to the uterus. For people who have a uterus, this procedure is meant to make it permanently virtually impossible for them to get pregnant. There are several methods of tubal ligation, but bilateral salpingectomy has come to be the preferred standard of care, because it is the most effective.<ref>ACOG Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention, Obstetrics & Gynecology: April 2019 - Volume 133 - Issue 4 - p e279-e284 doi: 10.1097/AOG.0000000000003164 Full text: https://journals.lww.com/greenjournal/Fulltext/2019/04000/ACOG_Committee_Opinion_No__774__Opportunistic.59.aspx</ref> For some [[transgender]] and [[nonbinary]] people, if their only concern about their uterus is that a risk of pregnancy is a source of distress and body dissonance (called [[gender dysphoria]]), this is an alternative to removing the uterus (called [[hysterectomy]]).<ref>Laura Erickson-Schroth, ed. ''Trans Bodies, Trans Selves: A Resource for the Transgender Community.'' Oxford University Press, 2014. Pp. 236, 267-268.</ref> Because this is not Wikipedia, this article should focus on common questions that transgender and nonbinary people have about this procedure, and should be written in simple English, so that people who are not doctors can easily understand it. | [[Tubal ligation]], also called getting one's tubes tied, and sometimes used to mean a bilateral salpingectomy (destroying both fallopian tubes), is a form of sterilization. Any method of tubal ligation works by stopping the path the egg cell would travel through the fallopian tube to the uterus. For people who have a uterus, this procedure is meant to make it permanently virtually impossible for them to get pregnant. There are several methods of tubal ligation, but bilateral salpingectomy has come to be the preferred standard of care, because it is the most effective.<ref name="ACOG774">ACOG Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention, Obstetrics & Gynecology: April 2019 - Volume 133 - Issue 4 - p e279-e284 doi: 10.1097/AOG.0000000000003164 Full text: https://journals.lww.com/greenjournal/Fulltext/2019/04000/ACOG_Committee_Opinion_No__774__Opportunistic.59.aspx</ref> For some [[transgender]] and [[nonbinary]] people, if their only concern about their uterus is that a risk of pregnancy is a source of distress and body dissonance (called [[gender dysphoria]]), this is an alternative to removing the uterus (called [[hysterectomy]]).<ref>Laura Erickson-Schroth, ed. ''Trans Bodies, Trans Selves: A Resource for the Transgender Community.'' Oxford University Press, 2014. Pp. 236, 267-268.</ref> Because this is not Wikipedia, this article should focus on common questions that transgender and nonbinary people have about this procedure, and should be written in simple English, so that people who are not doctors can easily understand it. | ||
Tubal ligation has no effect on the person's menstrual flow, menstrual cycle, hormone balance, the ability to orgasm, vulnerability to sexually transmitted infections,<ref name="planned parenthood">"Sterilization." ''Planned Parenthood.'' Retrieved July 9, 2020. https://www.plannedparenthood.org/learn/birth-control/sterilization</ref> or when or how the person will go through menopause.<ref>Deborah B. Nelson; Mary D. Sammel; Ellen W. Freeman; Clarisa R. Gracia; Li Liu; Elizabeth Langan (2005). "Tubal ligation does not affect hormonal changes during the early menopausal transition." ''Contraception'', 71(2), 0–110. doi:10.1016/j.contraception.2004.09.008 https://www.sciencedirect.com/science/article/abs/pii/S0010782404002756</ref> It does not elevate any cancer risks, and lowers ovarian cancer risk.<ref name="brinton cancer">Brinton LA, Gammon MD, Coates RJ, Hoover RN. “Tubal ligation and risk of breast cancer.” British Journal of Cancer 2000 May; 82(9), 1600–1604. doi:10.1054/bjoc.1999.1182 </ref><ref name="turney">Lyn Turney (1993). "Risk and contraception: What women are not told about tubal ligation." ''Women's Studies Int. Forum'', 16(5), 471–486. doi:10.1016/0277-5395(93)90097-s</ref> Sometimes a person can choose to have [[uterine ablation]] done at the same time as tubal ligation, which is supposed to stop menstrual flow. If someone chooses to get ablation, then they have to get a tubal ligation or some other kind of contraception too.<ref name="donnadieu 2007"> A.C. Donnadieu; X. Deffieux; A. Gervaise; E. Faivre; R. Frydman; H. Fernandez (2007). "Essure® sterilization associated with endometrial ablation." ''International Journal of Gynecology and Obstetrics'', 97(2), 0–142. doi:10.1016/j.ijgo.2007.02.009 | Tubal ligation has no effect on the person's menstrual flow, menstrual cycle, hormone balance, the ability to orgasm, vulnerability to sexually transmitted infections,<ref name="planned parenthood">"Sterilization." ''Planned Parenthood.'' Retrieved July 9, 2020. https://www.plannedparenthood.org/learn/birth-control/sterilization</ref> or when or how the person will go through menopause.<ref>Deborah B. Nelson; Mary D. Sammel; Ellen W. Freeman; Clarisa R. Gracia; Li Liu; Elizabeth Langan (2005). "Tubal ligation does not affect hormonal changes during the early menopausal transition." ''Contraception'', 71(2), 0–110. doi:10.1016/j.contraception.2004.09.008 https://www.sciencedirect.com/science/article/abs/pii/S0010782404002756</ref> It does not elevate any cancer risks, and lowers ovarian cancer risk.<ref name="brinton cancer">Brinton LA, Gammon MD, Coates RJ, Hoover RN. “Tubal ligation and risk of breast cancer.” British Journal of Cancer 2000 May; 82(9), 1600–1604. doi:10.1054/bjoc.1999.1182 </ref><ref name="turney">Lyn Turney (1993). "Risk and contraception: What women are not told about tubal ligation." ''Women's Studies Int. Forum'', 16(5), 471–486. doi:10.1016/0277-5395(93)90097-s</ref> Sometimes a person can choose to have [[uterine ablation]] done at the same time as tubal ligation, which is supposed to stop menstrual flow. If someone chooses to get ablation, then they have to get a tubal ligation or some other kind of contraception too.<ref name="donnadieu 2007"> A.C. Donnadieu; X. Deffieux; A. Gervaise; E. Faivre; R. Frydman; H. Fernandez (2007). "Essure® sterilization associated with endometrial ablation." ''International Journal of Gynecology and Obstetrics'', 97(2), 0–142. doi:10.1016/j.ijgo.2007.02.009 | ||
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[[File:Sterilizace ženy.jpg|thumb|A diagram of some-- but not all-- methods of tubal ligation.]] | [[File:Sterilizace ženy.jpg|thumb|A diagram of some-- but not all-- methods of tubal ligation.]] | ||
Some regions have laws that make it so that a person has to be certain age before they are allowed to get a tubal ligation. Tubal ligation is done by written informed consent from the patient, without needing a diagnosis of any health problem. | Some regions have laws that make it so that a person has to be certain age before they are allowed to get a tubal ligation.{{Citation needed}} Tubal ligation is done by written informed consent from the patient, without needing a diagnosis of any health problem. | ||
Anyone seeking sterilization will encounter sexist discrimination. Doctors, local laws, and health insurance companies put many more obstacles in the way of sterilization for people who they perceive as female, because of a widespread misconception that everyone who was born with a uterus will want to get pregnant someday. By comparison, doctors are much more willing and cooperative about giving the equivalent sterilization procedure to people who have testicles (a [[vasectomy]]). A doctor will only let a patient sign the consent forms for tubal ligation in the first place if the doctor is satisfied with how the patient answers a long series of intentionally offensive questions. Doctors intentionally try to lead people into giving the "wrong" answers, and then refuse to let the patient sign the consent forms. A survey found that male and female doctors are equally reluctant to let a "young" person (in their 20s or 30s) get a tubal ligation. Looking too youthful or whimsical can be enough for the doctor to decide you don't look like you can consider this decision, so dress maturely for this appointment.<ref name="misa">Misa, “How to get your tubes tied, even if you’re only 21.” ''Misa's Place'' (blog). Posted September 21, 2006. Accessed July 1, 2013. https://web.archive.org/web/20130701000000*/http://misasplace.blogspot.com/2006/09/how-to-get-your-tubes-tied-even-if.html</ref> See [[sterilization]] for more details on what the doctor wants to hear. There is also racist discrimination involved: doctors make sterilization relatively obtainable for people of color, or even push it on people of color who don't want it, but make sterilization almost impossible to obtain for people who are white. The motivation behind this racist discrimination is eugenics. After signing these consent forms, the patient may be required to wait a certain number of days before being allowed to have surgery, according to local laws or the person's health insurance. The wait is to give the patient time to make sure it's what they really want. This is also sexist discrimination, because people seeking a vasectomy are not forced to wait.<ref name="planned parenthood" /><ref name="jezebel">Erin Gloria Ryan, “Getting your tubes tied is a giant pain in the ass.” Published July 9, 2012. ''Jezebel'' (magazine). http://jezebel.com/5924414/getting-your-tubes-tied-is-a-giant-pain-in-the-ass</ref><ref name="lowder">J. Lowder, “Sterilize me, please.” ''Slate'' (magazine). Posted July 9, 2012. Accessed May 4, 2012. http://www.slate.com/articles/double_x/doublex/2012/07/getting_your_tubes_tied_why_do_young_women_have_a_hard_time_getting_sterilized_.3.html</ref> Even after submitting the consent forms, the doctors usually continue to create obstacles, such as deciding that the consent forms need to be redone because the doctor didn't print their name below their signature, or canceling the surgery at the last minute because the patient didn't call to confirm that they still wanted it. | Anyone seeking sterilization will encounter sexist discrimination. Doctors, local laws, and health insurance companies put many more obstacles in the way of sterilization for people who they perceive as female, because of a widespread misconception that everyone who was born with a uterus will want to get pregnant someday. By comparison, doctors are much more willing and cooperative about giving the equivalent sterilization procedure to people who have testicles (a [[vasectomy]]). A doctor will only let a patient sign the consent forms for tubal ligation in the first place if the doctor is satisfied with how the patient answers a long series of intentionally offensive questions. Doctors intentionally try to lead people into giving the "wrong" answers, and then refuse to let the patient sign the consent forms. A survey found that male and female doctors are equally reluctant to let a "young" person (in their 20s or 30s) get a tubal ligation. Looking too youthful or whimsical can be enough for the doctor to decide you don't look like you can consider this decision, so dress maturely for this appointment.<ref name="misa">Misa, “How to get your tubes tied, even if you’re only 21.” ''Misa's Place'' (blog). Posted September 21, 2006. Accessed July 1, 2013. https://web.archive.org/web/20130701000000*/http://misasplace.blogspot.com/2006/09/how-to-get-your-tubes-tied-even-if.html</ref> See [[sterilization]] for more details on what the doctor wants to hear. There is also racist discrimination involved: doctors make sterilization relatively obtainable for people of color, or even push it on people of color who don't want it, but make sterilization almost impossible to obtain for people who are white. The motivation behind this racist discrimination is eugenics. After signing these consent forms, the patient may be required to wait a certain number of days before being allowed to have surgery, according to local laws or the person's health insurance. The wait is to give the patient time to make sure it's what they really want. This is also sexist discrimination, because people seeking a vasectomy are not forced to wait.<ref name="planned parenthood" /><ref name="jezebel">Erin Gloria Ryan, “Getting your tubes tied is a giant pain in the ass.” Published July 9, 2012. ''Jezebel'' (magazine). http://jezebel.com/5924414/getting-your-tubes-tied-is-a-giant-pain-in-the-ass</ref><ref name="lowder">J. Lowder, “Sterilize me, please.” ''Slate'' (magazine). Posted July 9, 2012. Accessed May 4, 2012. http://www.slate.com/articles/double_x/doublex/2012/07/getting_your_tubes_tied_why_do_young_women_have_a_hard_time_getting_sterilized_.3.html</ref> Even after submitting the consent forms, the doctors usually continue to create obstacles, such as deciding that the consent forms need to be redone because the doctor didn't print their name below their signature, or canceling the surgery at the last minute because the patient didn't call to confirm that they still wanted it. | ||
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==Complications and risks== | ==Complications and risks== | ||
Statistics show that sterilization by tubal ligation is safer than giving birth.<ref name="strauss 1984">Strauss LT, Huezo CM, Kramer DG, Rochat RW, Senanayake P, Rubin GL. Sterilization-associated deaths: a global survey. International Journal of Gynaecology and Obstetrics. 1984 Feb;22(1):67-75. doi: 10.1016/0020-7292(84)90106-1. PMID: 6144595.</ref> Since tubal ligation is a surgery done under general anesthesia, it has the same risks of any such surgery, plus a few of its own distinctive risks, depending on the method used. Like any surgery, the most common serious risks are from infection, complications from the anesthesia, and bleeding too much (hemorrhage).<ref name="strauss 1984" /> Death from tubal ligation is extremely rare, and is usually caused by a reaction to anesthesia.<ref name="planned parenthood" /> | Statistics show that sterilization by tubal ligation is safer than giving birth.<ref name="strauss 1984">Strauss LT, Huezo CM, Kramer DG, Rochat RW, Senanayake P, Rubin GL. Sterilization-associated deaths: a global survey. International Journal of Gynaecology and Obstetrics. 1984 Feb;22(1):67-75. doi: 10.1016/0020-7292(84)90106-1. PMID: 6144595.</ref> Since tubal ligation is a surgery done under general anesthesia, it has the same risks of any such surgery, plus a few of its own distinctive risks, depending on the method used. Like any surgery, the most common serious risks are from infection, complications from the anesthesia, and bleeding too much (hemorrhage).<ref name="strauss 1984" /> Systemic infection (sepsis) is an extremely rare complication. Death from tubal ligation is extremely rare, and is usually caused by a reaction to anesthesia.<ref name="planned parenthood" /> | ||
During the surgery, there is a low risk that a bubble of air might get into a blood vessel (an embolism), which can cause the heart to stop (cardiac arrest). That can cause the patient to die on the operating table, but usually surgeons can restart the heart and resuscitate the patient.<ref>Duncan C. Carbon dioxide embolism during laparoscopy: a case report. AANA Journal. 1992 Apr;60(2):139-44. PMID: 1414176.</ref><ref>Ostman PL, Pantle-Fisher FH, Faure EA, Glosten B. Circulatory collapse during laparoscopy. Journal of Clinical Anesthesia. 1990 Mar-Apr;2(2):129-32. doi: 10.1016/0952-8180(90)90068-e. PMID: 2140690.</ref> | During the surgery, there is a low risk that a bubble of air might get into a blood vessel (an embolism), which can cause the heart to stop (cardiac arrest). That can cause the patient to die on the operating table, but usually surgeons can restart the heart and resuscitate the patient.<ref>Duncan C. Carbon dioxide embolism during laparoscopy: a case report. AANA Journal. 1992 Apr;60(2):139-44. PMID: 1414176.</ref><ref>Ostman PL, Pantle-Fisher FH, Faure EA, Glosten B. Circulatory collapse during laparoscopy. Journal of Clinical Anesthesia. 1990 Mar-Apr;2(2):129-32. doi: 10.1016/0952-8180(90)90068-e. PMID: 2140690.</ref> | ||
Tubal ligation does not increase the risk of cancer, not even hormone-sensitive types of breast cancer.<ref name="brinton cancer" /> Tubal ligation correlates with a much lower rate of ovarian cancer.<ref name="brinton cancer" /><ref>Heidi L. Miracle-McMahill, Eugenia E. Calle, Andrzej S. Kosinski, Carmen Rodriguez, Phyllis A. Wingo, Michael J. Thun, Clark W. Heath, Jr., Tubal Ligation and Fatal Ovarian Cancer in a Large prospective Cohort Study, American Journal of Epidemiology, Volume 145, Issue 4, 15 February 1997, Pages 349–357, https://doi.org/10.1093/oxfordjournals.aje.a009112 Full text: https://academic.oup.com/aje/article/145/4/349/69111</ref> | |||
==Effectiveness and pregnancy risks== | |||
[[File:Ectopic_Pregnancy.png|thumb|Some types of ectopic pregnancies in a uterus that hasn't had tubal ligation.]] | |||
Most methods of tubal ligation are about 99% effective or greater in preventing pregnancy.<ref name="ACOG208">{{Cite journal|date=March 2019|title=ACOG Practice Bulletin No. 208: Benefits and Risks of Sterilization|journal=Obstetrics & Gynecology|language=en|volume=133|issue=3|pages=e194–e207|doi=10.1097/AOG.0000000000003111|issn=0029-7844|pmid=30640233|author1=American College of Obstetricians Gynecologists' Committee on Practice Bulletins—Gynecology|s2cid=58625472}}</ref> A pregnancy can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, or if the tubes later reconnected (recanalization), so that there was enough of an opening in the tube for an egg or sperm to pass through. If someone does get pregnant after a tubal ligation, then the embryo might implant somewhere wrong. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnancy) or in the fallopian tube (a tubal pregnancy), the embryo generally can't survive,<ref>{{cite journal | vauthors = Zhang J, Li F, Sheng Q | s2cid = 35923100 | title = Full-term abdominal pregnancy: a case report and review of the literature | journal = Gynecologic and Obstetric Investigation | volume = 65 | issue = 2 | pages = 139–41 | date = 2008 | pmid = 17957101 | doi = 10.1159/000110015 }}</ref> For the pregnant person, an ectopic pregnancy is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery.<ref name=kirk2013>{{cite journal | vauthors = Kirk E, Bottomley C, Bourne T | title = Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location | journal = Human Reproduction Update | volume = 20 | issue = 2 | pages = 250–61 | year = 2014 | pmid = 24101604 | doi = 10.1093/humupd/dmt047 | doi-access = free }}</ref> Worldwide, pregnancy happens after the cutting, tying, or blocking methods of tubal ligation in 1 in 200 cases; of those pregnancies, 1 in 10 of them were ectopic pregnancies.<ref name="Date">Date, Shilpa Vishwas et al. “Female sterilization failure: Review over a decade and its clinicopathological correlation.” International journal of applied & basic medical research vol. 4,2 (2014): 81-5. doi:10.4103/2229-516X.136781 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137647/</ref> However, the preferred method, salpingectomy, destroys the whole fallopian tubes, which makes it far safer for preventing pregnancies (ectopic or otherwise) than tubal ligation methods that only cut, tie, or block the tubes. There have only been two reported cases worldwide of any kind of pregnancy happening after bilateral salpingectomy.<ref name"Bollapragada">Bollapragada, Shrikant S et al. “Spontaneous pregnancy after bilateral salpingectomy.” ''Fertility and sterility'' vol. 83,3 (2005): 767-8. doi:10.1016/j.fertnstert.2004.07.970 Full text: https://www.fertstert.org/article/S0015-0282(04)02993-0/fulltext</ref> | |||
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